1992866263 NPI number — CENTRAL REFERENCE LABORATORY INC

Table of content: (NPI 1992866263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992866263 NPI number — CENTRAL REFERENCE LABORATORY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL REFERENCE LABORATORY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DIAMOND REFERENCE LABORATORY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992866263
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1470 S.VALLEY VISTA DR
Provider Second Line Business Mailing Address:
100
Provider Business Mailing Address City Name:
DIAMOND BAR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91765-3903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-861-6966
Provider Business Mailing Address Fax Number:
909-860-6396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1470 S.VALLEY VISTA DR
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
DIAMOND BAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91765-3903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-861-6966
Provider Business Practice Location Address Fax Number:
909-860-6396
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAJAEE
Authorized Official First Name:
ABBAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
90908616966

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLF4032 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CLF4032 . This is a "LAB" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: LAB04032F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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